Clinical features of Behcet’s uveitis in patients with herpesvirus reactivation

Purpose. To study the possible impact of human herpes viruses (HHV) reactivation: herpes simplex virus type 1 (HSV 1), type 2 (HSV 2), cytomegalovirus (CMV) and Epstein — Barr virus (EBV) on the clinical course of uveitis in Behcet's disease (BD). Material and methods. Serum samples of 106 BD patients (ave. age 39) with uveitis were examined for the presence of antibodies — serological markers of chronic HHV infection and reactivation. Results. In 65 patients (25 with active uveitis (UA), 40 with uveitis remission (UR)), HHV reactivation was detected (mainly HSV 1, less often HSV 2, CMV and EBV — in individual cases), 41 patients had chronic HHV (17 with UA, 24 with UR). Certain clinical symptoms of uveitis were found to depend on HHV activity. Clinical signs of active uveitis (cells in the vitreous body), as well as severe irreversible changes (social blindness and low vision) were significantly more frequently detected in cases of HHV reactivation (p < 0.05) than in chronic HHV. The data obtained allow us to suggest, with some caution, that a subclinical HHV reactivation which stays after the onset of clinical uveitis remission, is an important factor of postuveal complications that are mainly manifested during remission. These complications include epiretinal fibrosis, pronounced optic nerve atrophy, and vasculitis (arterial and venous occlusion). Conclusion. The remission period in patients with subclinical herpesvirus activity is less favorable than in patients without serological markers of HHV reactivation. HHV reactivation that persists after uveitis activity is stopped can contribute to sudden exacerbations of uveitis.

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